6533b7d2fe1ef96bd125ec08

RESEARCH PRODUCT

Choice and Outcomes of Rate Control versus Rhythm Control in Elderly Patients with Atrial Fibrillation: A Report from the REPOSI Study

Francesco PaciulloMarco ProiettiVanessa BianconiNobili AlessandroMatteo PirroPier Mannuccio MannucciGregory Y. H. LipGraziana LupattelliPier Mannuccio MannucciAlessandro NobiliMauro TettamantiLuca PasinaCarlotta FranchiFrancesco PerticoneFrancesco SalernoSalvatore CorraoAlessandra MarengoniGiuseppe LicataFrancesco VioliGino Roberto CorazzaMaura MarcucciTarek Kamal EldinMaria Pia Donatella Di BlancaGiovanna LanzoSarah AstutoMauro TettamantiIlaria ArdoinoLaura CortesiDomenico PriscoElena SilvestriCaterina CenciGiacomo EmmiGianni BioloGianfranco GuarnieriMichela ZanettiGiovanni FernandesMassimiliano ChiuchMassimo VanoliGiulia GrignaniGianluca CasellaEdoardo Alessandro PulixiMauro BernardiSilvia Li BassiLuca SantiGiacomo ZaccheriniElmo MannarinoGraziana LupattelliVanessa BianconiFrancesco PaciulloRanuccio NutiRoberto ValentiMartina RuvioSilvia CappelliAlberto PalazzuoliTeresa SalvatoreFerdinando Carlo SassoDomenico GirelliOliviero OlivieriThomas MatteazziMario BarbagalloLidia PlancesRoberta AlcamoGiuseppe LicataLuigi CalvoMaria ValentiMarco ZoliRaffaella ArnòFranco Laghi PasiniPier Leopoldo CapecchiMaurizio BicchiGiuseppe PalascianoMaria Ester ModeoMaria PeragineFabrizio PappagalloStefania PuglieseCarla Di GennaroAlfredo PostiglioneMaria Rosaria BarbellaFrancesco De StefanoMaria Domenica CappelliniGiovanna FabioSonia SeghezziMargherita Migone De AmicisMarta MancarellaDaniela MariPaolo Dionigi RossiSarah DamantiBarbara Brignolo OttoliniGiulia BoniniGino Roberto CorazzaEmanuela MiceliMarco Vincenzo LentiDonatella PadulaGiovanni MurialdoAlessio MarraFederico CattaneoMaria Beatrice SecchiDavide GhelfiLuigi AnastasioLucia SofiaMaria CarboneGiovanni DavìMaria Teresa GuagnanoSimona SestiliGerardo MancusoDaniela CalipariMosè BartoneMaria Rachele MeroniPaolo Cavallo PerinBartolomeo LorenzatiGabriella GrudenGraziella BrunoCristina AmionePaolo FornengoRodolfo TassaraDeborah MelisLara RebellaGiuseppe DelitalaVincenzo PrettiMaristella Salvatora MasalaChiara PesLuigi BolondiLeonardo RascitiIlaria SerioFilippo Rossi FanelliAntonio AmorosoAlessio MolfinoEnrico PetrilloGiuseppe ZuccalàFrancesco FranceschiGuido De MarcoCordischi ChiaraSabbatini MartaGabriella D’aurizioGiuseppe RomanelliClaudia AmoliniDeborah ChiesaAlessandra MarengoniAntonio PicardiUmberto Vespasiani GentilucciPaolo GalloGiorgio AnnoniMaurizio CorsiSara ZazzettaGiuseppe BellelliHajnalka SzaboFranco ArturiElena SuccurroMariangela RubinoGiorgio SestiPaola LoriaMaria Angela BecchiGianfranco MartucciAlessandra FantuzziMauro MaurantonioMaria Grazia SerraMaria Antonietta BleveLaura GasbarroneMaria Rosaria SajevaAntonio BrucatoSilvia GhidoniPaola Di CoratoGiancarlo AgnelliEmanuela MarchesiniFabrizio FabrisMichela CarlonFrancesca TurattoAldo BaritussoFrancesca TurattoAnnalisa AmabileElisabetta OmenettoPaolo ScarinziRoberto ManfrediniChristian MolinoMarco PalaFabio FabbianBenedetta BoariAlfredo De GiorgiGiuseppe PaolissoMaria Rosaria RizzoMaria Teresa LaietaGiovanbattista RiniPasquale MansuetoIlenia PepeClaudio BorghiEnrico StrocchiValeria De SandoIlaria PareoCarlo SabbàFrancesco Saverio VellaPatrizia SuppressaRaffaella ValerioPasquale AgostiFlavia FontanaFrancesca LoparcoStefania PuglieseCaterina CapobiancoLuigi FenoglioChristian BraccoAlessia Valentina GiraudoElisa TestaCristina SerrainoSilvia FargionPaola BonaraGiulia PeritiMarianna PorzioSlivia TiraboschiFlora PeyvandiAlberto TedeschiRaffaella RossioBarbara FerrariValter MonzaniValeria SavojardoChristian FolliMaria MagniniFrancesco SalernoAlessio ConcaGiulia GobboAlessio ConcaGiada PalliniMiriam ValentiCarlo L. BalduiniGiampiera BertolinoStella ProviniFederica QuagliaFranco DallegriLuciano OttonelloLuca LiberaleWu Sheng ChinLaura CarassaleSilvia CaporotundoGiancarlo TraisciLucrezia De FeudisSilvia Di CarloNicola Lucio LiberatoAlberto BurattiTiziana TogninGiovanni Battista BianchiSabrina GiaquintoFrancesco PurrelloAntonino Di PinoSalvatore PiroRenzo RozziniLina FalangaElena SpazziniGiuseppe MontrucchioElisabetta GrecoPietro TizzaniPaolo PetittiAntonio PerciccanteAlessia CoralliRaffaella SalmiPiergiorgio GaudenziSusanna GamberiniAndrea SempliciniLucia GottardoGianluigi VendemialeGaetano ServiddioRoberta ForlanoCesare MasalaAntonio MammarellaValeria RaparelliFrancesco VioliStefania BasiliLudovica PerriRaffaele LandolfiMassimo MontaltoAntonio MirijelloCarla ValloneMartino BellusciDonatella SettiFilippo PedrazzoliLuigina GuastiLuana CastiglioniAndrea MarescaAlessandro SquizzatoMarta MolaroMarco BertolottiChiara MussiMaria Vittoria LibbraAndrea MiceliElisa PellegriniLucia CarulliFrancesca VeltriFrancesco PerticoneAngela SciacquaMichele QueroChiara BagnatoLidia ColangeloTania FalboRoberto De GiorgioMauro SerraValentina GrassoEugenio RuggeriBenzoni IlariaAndrea SalviRoberto LeonardiChiara GrassiniIlenia MascheronaGiorgio MinelliFrancesca MalteseGiampaolo DamianiWilliam CapeciMassimo MattioliGiuseppe Pio MartinoLorenzo BiondiMonica OrmasPietro PettinariRoberto RomitiSalvatore CorraoSilvia MessinaFederica CavallaroRiccardi GhioSerena FavoriniAnna Dal ColSalvatore MinisolaLuciano ColangeloAntonella AfeltraPamela AlemannoBenedetta MariglianoMaria Elena PipitaPietro CastellinoJulien BlancoLuca ZanoliMarco CattaneoPaola FracassoMaria Valentina AmorusoValter SaraccoMarisa FogliatiCarlo BussolinoVittorio DuranteGiovanna EusebiDaniela TirottaFrancesca MeteMiriam GinoAntonio CittadiniCarlo VigoritoMichele ArcopintoAndrea SalzanoEmanuele BobbioAlberto Maria MarraDomenico SiricoGuido MoreoFrancesco ScopellitiFrancesca GaspariniMelissa CoccaAlberto BallestreroFabio FerrandoSergio BerraSimonetta DassiMaria Cristina NavaBruno GraziellaSilvia GhidoniCristina AmioneStefano BaldassarreSalvatore FragapaniGabriella GrudenGiorgio GalantiGabriele MascheriniCristian PetriLaura StefaniMargherita GirinoValeria PiccinelliFrancesco NassoVincenza GioffrèMaria PasqualeGiuseppe ScattolinSergio MartinelliMauro TurrinLeonardo SechiCristina CatenaGianluca ColussiRamirez Duque NievesMuela Molinero AlbertoAbad Requejo PedroLopez Pelaez VanessaTamargo LaraCorbella Viros XavierFormiga FrancescDiez Manglano JesusBejarano Tello EsperanzaDel Corral Behamonte EstherSevil Puras MariaManuel RomeroPinilla Llorente BlancaLopez Gonzalez-cobos CristinaVillalba Garcia M. VictoriaLopez SaezJuan BoscoSanz Baena SusanaArroyo Gallego MartaGonzalez Becerra ConcepcionFernandez Moyano AntonioMercedes Gomez HernandezManuel Poyato BorregoPacheco Cuadros RaquelPerez Rojas FlorenciaGarcia Olid BeatrizCarrascosa Garcia SaraGonzalez-cruz Cervellera AlfonsoPeinado Martinez MartaSara Carrascosa GarciaRuiz Cantero AlbertoAlbarracín Arraigosa AntonioGodoy Guerrero MontserratBarón Ramos Miguel ÁNgelMachin Jose ManuelNovo Veleiro IgnacioAlvela Suarez LucíaLopez AlfonsoRubal Bran DavidIñiguez Vazquez IriaRios Prego Monica

subject

MaleAnti-Arrhythmia Agents/therapeutic useantiarrhythmic agentComorbidityAged; Aged 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Comorbidity; Diabetes Mellitus; Female; Heart Failure; Heart Rate; Hospitalization; Humans; Male; Odds Ratio; Polypharmacy; Prevalence; Geriatrics and Gerontology; Pharmacology (medical)030204 cardiovascular system & hematologyanticoagulant agentDiabetes Mellitus/drug therapy0302 clinical medicineHeart RateAtrial Fibrillation80 and overOdds RatioPrevalencePharmacology (medical)030212 general & internal medicineLS4_4Aged 80 and overantiarrhythmic agent anticoagulant agent antithrombocytic agent calcium channel blocking agent digoxinHeart Rate/drug effectsDiabetes MellituAtrial fibrillationantithrombocytic agentdigoxinHospitalizationAnti-Arrhythmia AgentFemaleAnti-Arrhythmia AgentsHumanmedicine.medical_specialtySocio-culturale-Geriatrics and Gerontology; Pharmacology (medical)03 medical and health sciencesInternal medicineDiabetes mellitusHeart rateantiarrhythmic agent; anticoagulant agent; antithrombocytic agent; calcium channel blocking agent; digoxinmedicineDiabetes MellitusHumansAgedPolypharmacyHeart Failurebusiness.industryAtrial Fibrillation/drug therapyOdds ratiomedicine.diseaseHeart Failure/drug therapyComorbidityConfidence intervalcalcium channel blocking agentHeart failurePolypharmacyAged; Aged 80 and over; Anti-Arrhythmia Agents; Atrial Fibrillation; Comorbidity; Diabetes Mellitus; Female; Heart Failure; Heart Rate; Hospitalization; Humans; Male; Odds Ratio; Polypharmacy; PrevalenceGeriatrics and Gerontologybusiness

description

Background: Among rate-control or rhythm-control strategies, there is conflicting evidence as to which is the best management approach for non-valvular atrial fibrillation (AF) in elderly patients. Design: We performed an ancillary analysis from the ‘Registro Politerapie SIMI’ study, enrolling elderly inpatients from internal medicine and geriatric wards. Methods: We considered patients enrolled from 2008 to 2014 with an AF diagnosis at admission, treated with a rate-control-only or rhythm-control-only strategy. Results: Among 1114 patients, 241 (21.6%) were managed with observation only and 122 (11%) were managed with both the rate- and rhythm-control approaches. Of the remaining 751 patients, 626 (83.4%) were managed with a rate-control-only strategy and 125 (16.6%) were managed with a rhythm-control-only strategy. Rate-control-managed patients were older (p = 0.002), had a higher Short Blessed Test (SBT; p = 0.022) and a lower Barthel Index (p = 0.047). Polypharmacy (p = 0.001), heart failure (p = 0.005) and diabetes (p = 0.016) were more prevalent among these patients. Median CHA2DS2-VASc score was higher among rate-control-managed patients (p = 0.001). SBT [odds ratio (OR) 0.97, 95% confidence interval (CI) 0.94–1.00, p = 0.037], diabetes (OR 0.48, 95% CI 0.26–0.87, p = 0.016) and polypharmacy (OR 0.58, 95% CI 0.34–0.99, p = 0.045) were negatively associated with a rhythm-control strategy. At follow-up, no difference was found between rate- and rhythm-control strategies for cardiovascular (CV) and all-cause deaths (6.1 vs. 5.6%, p = 0.89; and 15.9 vs. 14.1%, p = 0.70, respectively). Conclusion: A rate-control strategy is the most widely used among elderly AF patients with multiple comorbidities and polypharmacy. No differences were evident in CV death and all-cause death at follow-up.

yearjournalcountryeditionlanguage
2018-01-01
10.1007/s40266-018-0532-8http://hdl.handle.net/10447/297762